Medicine and Health Sciences Commons^™

Insights Into The Problem Of Alarm Fatigue With Physiologic Monitor Devices: A Comprehensive Observational Study Of Consecutive Intensive Care Unit Patients, Barbara J. Drew, Patricia Harris, Jessica K. Zègre-Hemsey, Tina Mammone, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, Xiao Hu

Collected Faculty and Staff Scholarship

Purpose: Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing ‘‘alarm fatigue’’ which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms.

Results: A total of 2,558,760 unique alarms occurred in the …

Heart Rate Variability Measured Early In Patients With Evolving Acute Coronary Syndrome And 1-Year Outcomes Of Rehospitalization And Mortality, Patricia R.E. Harris, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Collected Faculty and Staff Scholarship

Objective: This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS).

Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established.

Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with �18 hours of sinus rhythm were selected for HRV analysis (number [N] �193). Time domain, frequency …

Heart Rate Variability Measurement And Clinical Depression In Acute Coronary Syndrome Patients: Narrative Review Of Recent Literature, Patricia R.E. Harris, Claire E. Sommargren, Phyllis K. Stein, Gordon L. Fung, Barbara J. Drew

Collected Faculty and Staff Scholarship

Aim: We aimed to explore links between heart rate variability (HRV) and clinical depression in patients with acute coronary syndrome (ACS), through a review of recent clinical research literature.

Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function.

Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search …

Effects Of Sertraline Treatment For Young Children With Fxs, Laura Greiss Hess, Peter Mundy, Randi Hagerman

Collected Faculty and Staff Scholarship

Phenotypic manifestations for young children with fragile X syndrome (FXS) include: anxiety, sensory processing challenges, global language and communication deficits and intellectual and developmental disabilities. Many of these symptoms can be treated with medications, including selective serotonin reuptake inhibitors (SSRIs). However to date a clinical trial has not been conducted for children under five years old.

This study investigated the following question: Are there group differences on developmental outcome measures for those children treated with sertraline compared to placebo?

Family Meanings, Contexts And Hopes Within A Clinical Trial, Laura Greis Hess, Cynthia Carter Ching, Randi Hagerman

Collected Faculty and Staff Scholarship

These qualitative analyses are a component of the clinical trial: “Effects of Sertraline Treatment for Young Children with FXS: Examination of Developmental Outcomes and Family Contexts.”

We argue that inclusion of a sociocultural perspective within the context of a clinical trial affords consideration of:

• A dynamic view of development – simultaneous consideration of biological and sociocultural factors (Vygotsky, 1978).
• Application of a bioecological framework and consideration of ever changing nested settings and contexts over time (Bronfenbrenner, 2005)

A Safety Mnemonic For Pediatric Oncology Patients: Knowledge, Confidence And Skills Accuracy During Simulation, Luanne Linnard-Palmer, Barbara Ganley

Collected Faculty and Staff Scholarship

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1]. Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2]. This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of …

Utility Of An Occupational Therapy Driving Intervention For A Combat Veteran, Sherrilene Classen, Miriam Monahan, Maria Canonizado, Sandra Winter

Collected Faculty and Staff Scholarship

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention …

Evidence-Based Review Of Interventions For Medically At-Risk Older Drivers, Sherilenne Classen, Miriam Monahan, Beth Auten, Abraham Yarney

Collected Faculty and Staff Scholarship

OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions.

METHOD. We used the American Occupational Therapy Association’s classification criteria (Levels I–V, I 5 highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A 5 strongly recommend the intervention; B 5 recommend intervention is provided routinely; C 5 weak evidence that the intervention can improve outcomes; D 5 recommend not to provide the intervention; I 5 insufficient evidence to recommend for or against the intervention.

RESULTS. For clients with stroke, we recommend a graded simulator …

Driving Errors In Parkinson’S Disease: Moving Closer To Predicting On-Road Outcomes, Sherrilene Classen, Babetter Brumback, Miriam Monahan, Irene I. Malaty, Ramon L. Rodriguez, Michael S. Okun, Nikolaus R. Mcfarland

Collected Faculty and Staff Scholarship

Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age 5 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age 5 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed …